Chapter 5 Integumentary System

Localized, Systemic

Lesions may affect tissue over an area of a definite size (______) or may be widely spread throughout the body (______). Evaluation of skin lesions, injuries, or changes to tissue helps establish the diagnosis of skin disorders. Lesions are also described by their appearance, color, location, and size as measured in centimeters.

Abcess

Localized collection ofpus at the site ofan infection (characteristically a staphylococcal infection)

Grade 2

• Tumor cells moderately or poorly differentiated • Less resemblance to tissue of origin• More variation in size and shape of tumor cells • Increased mitoses

Grade 3

• Tumor cells poorly differentiated • Increased abnormality in appearance, with only remote resemblance to the tissue of origin • Marked variation in shape and size of tumor cells • Gready increased mitoses

Grade 4

• Tumor cells very poorly differentiated • Abnormal appearance to the extent that recognition of the tumor's tissue origin is difficult • Extreme variation in size and shape of tumor cells

Grade 1

• Tumor cells well differentiated • Close resemblance to tissue of origin and, thus, retaining some specialized functions

Male

Integumentary System: ______ Reproductive • Receptors in the skin respond to sexual stimuli.

Female

Integumentary System: ______ Reproductive • Subcutaneous receptors provide pleasurable sensations associated with sexual behavior. • Skin stretches to accommodate the growing fetus during pregnancy.

Secondary

Lesions are described as primary or secondary. ______ skin lesions are changes that take place in the primary lesion as a result of infection, scratching, trauma, or various stages of a disease.

Primary

Lesions are described as primary or secondary. ______ skin lesions are the initial reaction to pathologically altered tissue and may be flat or elevated.

Strata

Although the epidermis is composed of several sublayers called ______, the (2) stratum corneum and the (3) basal layer, which is the deepest layer, are of greatest importance.

Keratin

As these cells move toward the stratum corneum to replace the cells that have been sloughed off, they die and become filled with a hard protein material called ______.

Impetigo

Bacterial skin infection characterized by isolated pustules that become crusted and rupture.

Immunotherapy

Cancer treatment includes surgery, chemotherapy, ______, and radiation therapy. Im- munotherapy, also called biotherapy, is a newer treatment that stimulates the body's own immune defenses to fight tumor cells.

Eczema

Chronic inflammatory skin condition that is characterized by erythema, papules, vesicles, pustules, scales, crusts, and scabs and accompanied by intense itching (pruritus); also called atopic dermatitis Eczema most commonly occurs during infancy and childhood, with decreasing incidence in adolescence and adulthood. Statistics support a convincing genetic component in that it tends to occur in patients with a family history of allergic conditions.

Digestive

Integumentary System: ______ • Skin absorbs vitamin D (produced when skin is exposed to sunlight), which is needed for intestinal absorption of calcium. • Excess calories are stored as subcutaneous fat.

Eschar

Dead matter that is sloughed off from the surface of the skin, especially after a burn. Eschar material is commonly crusty or scabbed.

Cellulitis

Diffuse (widespread), acute infection ofthe skin and subcutaneous tissue Cellulitis is characterized by a light, glossy appearance of the skin, localized heat, redness, pain, and swelling, occasionally with fever, malaise, and chills.

Root, Bed, Body, Lunula

Each nail is formed in the (1) nail ______ and is composed of keratinized, stratified, squamous epithelial cells producing a very tough covering. As the nail grows, it stays attached and slides forward over the layer of epithelium called the (2) nail______. This epithelial layer is continuers with the epithelium of the skin. Most of the (3) nail ______ appears pink because of the underlying vascular tissue. The half-moon-shaped area at the base of the nail, the (4) ______, is the region where new growth occurs. The lunula has a whitish appearance because the vascular tissue underneath does not show through.

Third

In ______-degree (full-dtickness) burns, the epidermis and dermis are destroyed, and some of the underlying connective tissue is damaged, leaving the skin waxy and charred with insensitivity to touch. The underlying bones, muscles, and tendons may also be damaged. These bums may be caused by corrosive chemicals, flames, electricity, or extremely hot objects; immersion of the body in ex- tremely hot water; or clothing that catches fire. Because of the extensiveness of tissue destruction ulcerating wounds develop, and the body attempts to heal itself by forming scar tissue. Skin grafting (dermatoplasty) is commonly required to protect the underlying tissue and assist in recovery.

Melanocytes

In the basal layer, special cells called ______ produce a black pigment called melanin.

Decubitus Ulcer

Inflammation, sore, or skin deterioration caused by prolonged pressure from lying in one position that prevents blood flow to the tissues, usually in elderly bedridden persons; also known as pressure ulcer. Pressure ulcers are most commonly found in skin overlying a bony projection, such as the hip, ankle, heel, shoulder, and elbow. The wounds are categorized from stage 1 to stage 4.

Acne

Inflammatory disease of the sebaceous glands and hair follicles of the skin with characteristic lesions that include blackheads (comedos), inflammatory papules, pustules, nodules, and cysts and are usually associated with seborrhea; also called acne vulgaris.

Defense

Integumentary System: Blood, Lymphatic, and Immune • Skin is the first line of ______ against the invasion of pathogens into the body.

Cutaneous

Integumentary System: Cardiovascular • ______ blood vessels dilate and constrict to help regulate body temperature.

Subcutaneous

Integumentary System: Endocrine • The ______ layer of the skin stores adipose tissue when insulin secretions cause excess carbohydrate intake to be stored as fat.

Nervous

Integumentary System: ______ • Cutaneous receptors detect stimuli related to touch, pain, pressure, and temperature.

Urinary

Integumentary System: ______ • Skin provides an alternative route for excreting salts and nitrogenous wastes in the form of perspiration.

Musculoskeletal

Integumentary System: ______ • Skin synthesizes the vitamin D needed for absorption of calcium, which is essential for muscle contraction. • Skin also synthesizes the vitamin D needed for growth, repair, and maintenance of bones.

Respiratory

Integumentary System: ______ • Skin temperature may influence respiratory rate. As temperature increases, respiratory rate may also increase. • Hairs ofthe nasal cavity filter particles from inspired air before it reaches the lower respiratory tract.

Anaplasia

On the other hand, a patient with a grade IV tumor shows cells that are very poorly differentiated and grow rapidly. These cells spread to sur- rounding tissue, revert back to their primitive state (______), and are incapable of carrying on the normal function of the tissue

Carcinogens

Other predisposing factors associated with this type of cancer include radiation therapy; chronic skin irritation and inflammation; exposure to cancer-causing agents (______), including tar and oil; hereditary diseases (such as xeroderma pigmentosum and albinism); and the presence of premalignant lesions (such as actinic keratosis or Bowen disease).

Alopecia

Partial or complete loss of hair resulting from normal aging, an endocrine disorder, a drug reaction, anticancer medication, or a skin disease; com- monly called baldness

Chloasma

Pigmentary skin discoloration usually occurring in yellowish-brown patches or spots.

Bulla

Primary Elevated Fluid Filled Lesion: ______ A vesicle or blister larger than 1 em in diameter. Examples: second-degree burns, severe poison oak, poison ivy.

Vesicle

Primary Elevated Fluid Filled Lesion: ______ Elevated, circumscribed, fluid-filled lesion less than 0.5 em in diameter. Examples: poison ivy, shingles, chickenpox.

Pustule

Primary Elevated Fluid Filled Lesion: ______ Small, raised, circumscribed lesion that contains pus; usually less than 1 em in diameter. Examples: acne, furuncle, pustular psoriasis, scabies.

Wheal

Primary Elevated Solid Lesion: ______ Elevated, firm, rounded lesion with localized skin edema (swelling) that varies in size, shape, and color; paler in the center than its surrounding edges; accompanied by itching. Examples: hives, insect bites, urticaria.

Nodule

Primary Elevated Solid Lesion: ______ Palpable, circumscribed lesion; larger and deeper than a papule (0.6 to 2 em in diameter); extends into the dermal area. Examples: intradermal nevus, benign or malignant tumor.

Tumor

Primary Elevated Solid Lesion: ______ Solid, elevated lesion larger than 2 em in diameter that extends into the dermal and subcutaneous layers. Examples: lipoma, steatoma, dermatofibroma, hemangioma.

Papule

Primary Elevated Solid Lesion: ______ Solid, elevated lesion less than 1 em in diameter that may be the same color as the skin or pigmented. Examples: nevus, wart, pimple, ringworm, psoriasis, eczema.

Macule

Primary Flat Lesion: ______ Flat, pigmented, circumscribed area less than 1 cm in diameter. Examples: freckle, flat mole, or rash that occurs in rubella.

Erythema

Redness of the skin caused by swelling of the capillaries. An example of erythema is a mild sunburn or nervous blushing.

Fissure

Secondary Depressed Lesion: ______ Small slit or cracklike sore that extends into the dermal layer; could be caused by continuous inflammation and drying.

Ulcer

Secondary Depressed Lesion: ______ UlcerAn open sore or lesion that extends to the dermis and usually heals with scarring. Examples: pressure sore, basal cell carcinoma.

Excoriations

Secondary Depressed Lesion: ______ Unear scratch marks or traumatized abrasions of the epidermis. Examples: scratches, abrasions, chemical or thermal burns.

Androgens

Sex hormones, particularly ______, regulate the production and secretion of sebum. During adolescence, secretions increase; as the person ages, secretions diminish. The loss of sebum, which lubricates the skin, may be one of the reasons for the formation of wrinkles that accompanies old age. Sebaceous glands are present over the en- tire body except on the soles of the feet and the palms of the hands. They are especially prevalent on the scalp and face; around such openings as the nose, mouth, external ear, and anus; and on the upper back.

Synthesizes

Skin ______ vitamin D (needed by bones for calcium absorption).

Ecchymosis

Skin discoloration consisting of a large, irregularly formed hemorrhagic area with colors changing from bluish black to greenish brown or yellow; commonly called a bruise.

Lentigo

Small brown macules, especially on the face and arms, brought on by sun exposure, usually in a middle-aged or older person.

Subcutaneous

The (5) ______ layer, also called the Hypodermis, binds the dermis to underlying structures. It is composed primarily of loose connective tissue and adipose (fat) tissue interlaced with blood vessels.

Sudoriferous

The ______ glands secrete perspiration, or sweat, onto the surface of the skin through pores. Pores are most plentiful on the palms, soles, forehead, and axillae (armpits). The main functions of the ______ glands are to cool the body by evaporation, excrete waste products, and moisten surface cells. (same word)

Integumentary

The ______ is an elaborate system of distinct tissues including glands that produce several types of. secretions, nerves that transmit impulses, and blood vessels that help regulate body temperature.

Integument

The ______ is the largest organ in the body.

Basal

The ______ layer is the only layer of the epidermis that is composed of living cells where new cells are formed.

Subcutaneous

The ______ layer stores fats, insulates and cushions the body, and regulates temperature. The amount of fat in the subcutaneous layer varies with the region of the body and sex, age, and nutritional state.

Skin

The ______ protects underlying structures from injury and provides sensory information to the brain. Beneath the skin's surface is an intricate network of nerve fibers that register sensations of tem- perature, pain, and pressure. Other important functions of the skin include protecting the body against ultraviolet rays, regulating body temperature, and preventing dehydration. The skin also acts as a reservoir for food and water. It also synthesizes vitamin D when exposed to sunlight. The skin consists of two distinct layers: the epidermis and the dermis. A subcutaneous layer of tissue binds the skin to underlying structures.

TMN

The ______ staging system classifies solid tumors by size and degree ofspread according to three basic criteria: •T- size and invasiveness of the primary tumor • N- area lymph nodes involved • M- invasiveness (metastasis) of the primary tumor

Skin

The ______, also called the integument, covers and protects all outer surfaces of the body and performs many vital functions, including the sense of touch.

Glands

The accessory organs of the skin consist of integumentary glands, hair, and nails. The ______ play an important role in defending the body against disease and maintaining homeostasis, whereas the hair and nails have more limited functional roles.

Ductules

The acidic nature of sebum helps destroy harmful organisms on the skin, thus preventing infection. When ______ of the sebaceous glands become blocked, acne may result. Congested sebum causes formation of pimples or whiteheads. If the sebum is dark, it forms blackheads

Papilla

The cluster of epithelial cells lying over the ______ reproduces and is responsible for the eventual formation of the hair shaft. As long as these cells remain alive, hair will regenerate even if it is cut, plucked, or otherwise removed.

Tumor, Mode, Metastasis

The most common system used for staging tumors is the ______, ______, ______ (TNM) system. It is an international system that allows comparison of statistics among cancer centers.

Epidermis

The outer layer of the skin, the (1) ______, is relatively thin over most areas but is thickest on the palms of the hands and the soles of the feet.

Keratin

The relatively waterproof characteristic of ______ prevents body fluids from evaporating and moisture from entering the body. The entire process by which a cell forms in the basal layer, rises to the surface, becomes keratinized, and sloughs off takes about 1 month.

Sebum

The sebaceous glands are filled with cells, the centers ofwhich contain fatty droplets. As these cells disintegrate, they yield an oily secretion called ______.

Dermis

The second layer of the skin, the (4) ______, also called the corium, lies directly beneath the epidermis. It is composed of living tissue and contains numerous capillaries, lymphatic vessels, and nerve endings. Hair follicles, sebaceous (oil) glands, and sudoriferous (sweat) glands are also located in the dermis.

Integumentary

The skin and accessory organs (hair, nails, and glands) make up the ______ System.

Epidermis, Dermis

The skin consists of two distinct layers: the ______ and the ______.

Corneum

The stratum ______ is composed of dead, flat cells that lack a blood supply and sensory re- ceptors. Its thickness is related to normal wear of the area it covers.

Shaft, Follicle, Papilla

The visible part of the hair is the (8) hair ______; the part that is embedded in the dermis is the hair root. The root, together with its coverings, forms the (9) hair ______. At the bottom of the follicle is a loop of capillaries enclosed in a covering called the (10) ______.

Second

______-degree (partial thickness) burns are deep burns that damage the epidermis and part of the dermis. These burns may be caused by contact with flames, hot liquids, or chemicals. Symptoms mimic those of first-degree bums, but fluid-filled blisters (vesicles or bullae) form, and the bum may heal with litde or no scarring.

Insitu, Invasive

There are two types of squamous cell carcinoma: those that are confined to the original site (______) and those that penetrate the surrounding tissue (______). Depending on the location, size, shape, degree of invasion, and condition of the underlying tissue, treatment is removal by surgical excision, cryotherapy, radiotherapy, or electrodesiccation and curettage. A combination of these treatment methods may be required for a deeply invasive tumor.

Keratosis

Thickened area of the epidermis or any horny growth on the skin (such as a callus or wart).

Combined

To provide the most effective treatment, the physician may prescribe one ofthe previously listed treatments or use a combination of them (______-Modality treatment).

Exocrine

Two important glands located in the dermis produce secretions: The (6) sudoriferous (sweat) glands produce sweat and the (7) sebaceous (oil) glands produce oil. These two glands are ______ glands because they secrete substances through ducts to an outer surface ofthe body rather than directly into the bloodstream.

Comedo

Typical small skin lesion of acne vulgaris caused by accumulation of keratin, bacteria, and dried sebum plugging an excretory duct of the skin. The closed form of comedo, called a whitehead, consists of a papule from which the contents are not easily expressed.

Pallor

Unnatural paleness or absence of color in the skin.

Bowen disease

Very early form of skin cancer, which is easily curable and characterized by a red, scaly patch on the skin; also called squamous cell carcinoma in situ. Treatment for Bowen disease includes curettage and electrodesiccation.

Alopecia

______ (baldness) occurs when the hairs of the scalp are not replaced because of death of the papillae (singular, papilla).

Sebaceous

______ Glands secrete sebum (oil) into the hair follicles where the hair shafts pass through the dermis.

Sudoriferous

______ Glands secrete sweat to the outside of the body; also assist in body temperature regulation.

Neoplasms

______ are abnormal growths of new tissue that are classified as benign or malignant.

Lesions

______ are areas of tissue that have been pathologically altered by injury, wound, or infection.

Burns

______ are tissue injuries caused by contact with thermal, chemical, electrical, or radioactive agents. Although burns generally occur on the skin, they can also affect the respiratory and di- gestive tract linings. Burns that have a local effect are not as serious as those that have a systemic effect. Systemic effects are life-threatening and may include dehydration, shock, and infection.

Squamous Cell Carcinoma

______ arises from skin that undergoes pathological hardening (keratinizing) of epidermal cells. It is an invasive tumor with potential for metastasis and occurs most commonly in fair-skinned white men over age 60. (See Fig. 5-7.) Repeated overexposure to the sun's ultraviolet rays greatly increases the risk of squamous cell carcinoma.

Homeostasis

______ encompasses the regulatory mechanisms of the body that control temperature, acidity, and the concentration of salt, food, and waste products.

Androgen

______ is a generic term for an agent (usually a hormone, such as testosterone or androsterone) that stimulates development of male characteristics. ______ regulate the production of sebum. (same word)

Homeostasis

______ is a state of equilibrium of the internal environment of the body despite changes in the external environment.

Ductule

______ is a very small duct.

Hair

______ is found on nearly all parts of the body except for the lips, nipples, palms of the hands, soles of the feet, and parts of the external genitalia.

Synthesize

______ means forming a complex substance by the union of simpler compounds or elements.

Benign

______ neoplasms are noncancerous growths composed of the same type of cells as the tissue in which they are growing. They harm the individual only insofar as they place pressure on or interfere with the functioning of surrounding structures. If the benign neoplasm remains small, it does not commonly require removal. When the tumor enlarges, causes pain, or interferes with other organs or structures, excision is necessary.

Malignant

______ neoplasms, also called cancer, are composed of cells that tend to become invasive and spread to remote regions of the body (metastasis). Once the malignant cells from the primary tumor invade surrounding tissues, they tend to enter blood and lymph vessels and travel to remote regions of the body to form secondary tumor sites. If left untreated, cancer tends to be progressive and generally fatal.

Nails

______ protect the tips of the fingers and toes from bruises and injuries.

Melanin

______ provides a protective barrier from the damaging effects of the sun's ultraviolet radiation, which can cause skin cancer.

Acne

______ results from thickening of the follicular opening, increased sebum production, and the presence of bacteria. It is associated with an inflammatory response. The face, neck, and shoulders are common sites for this condition.

Malignant Melanoma

______, as the name implies, is a malignant growth of melanocytes. (See Fig. 5-8.) This tumor is highly metastatic, with a higher mortality rate than basal or squamous cell carcinomas. It is the most lethal of the skin cancers and can metastasize extensively to the liver, lungs, or brain.

Basal Cell Carcinoma

______, the most common type of skin cancer, is a malignancy of the basal layer of the epidermis, or hair follicles. This type of cancer is commonly caused by overexposure to sunlight. The tumors are locally invasive but rarely metastasize.

First

______-degree (superficial) burns are the least serious type of burn because they injure only the top layers of the skin, the epidermis. These burns are most commonly caused by brief contact with dry or moist heat (thermal burn), spending too much time in the sun (sunburn), or exposure to chemicals (chemical burn). Injury is restricted to local effects, such as skin redness (erythema) and acute sensitivity to such sensory stimuli as touch, heat, or cold (hyperesthesia). Generally, blisters do not form, and the bum heals without scar formation.